Acta Gastroenterologica Latinoamericana最新文献

Mid-gastrointestinal bleeding is considered an uncommon pathology, representing approximately 5 to 10% of all gas- trointestinal tract bleedings. Over the last few decades, significant advancements in the study of the small intestine have considerably improved diagnosis, resulting in a detection rate of the etiology close to 75%. Despite these developments, clinical presentation, diagnosis, and therapeutic approach continue to be a challenge in medical practice. Effectively managing this condition largely depends on thoroughly assessing the patient's medical history, properly considering underlying lesions, and correctly implementing available diagnostic and therapeutic tools. Therefore, this review aims to address the current definitions of mid-gastrointestinal bleeding, its etiology, along with its diagnostic and therapeutic approach, to guide the management of this patholog.

Introduction: Digestive endoscopy is a fundamental tool in the practice of pediatric gastroenterology, being crucial in the diagnosis and treatment of various pathologies such as foreign body ingestion. The incidence of these events is relevant in the pediatric population, with potential health risks.

Aim: This study aims to describe the reasons for performing urgent/emergency endoscopies in a pediatric ward at the most complex General Hospital in Patagonia, Argentina.

Material and methods: Descriptive, cross-sectional, retrospective, and observational study in the most important General Hospital of the Argentine Patagonia. Demographic data, clinical presentation, time of the procedure, endoscopic characteristics, causes and medical evolution of patients under 15 years of age admitted for pediatric emergencies were collected. Classification criteria were used to evaluate the severity of the lesions.

Results: A total of 105 cases were analyzed, predominantly in girls with a mean age of 4.5 years. Most cases involved foreign body ingestion, followed by caustic injuries and gastrointestinal bleeding. Endoscopies were mainly performed on Fridays. Coins were the most frequent foreign body, while caustic injuries were mainly alkaline. All patients progressed favorably, with no complications arising from the procedure.

Conclusion: Foreign body ingestion was the most common reason in the pediatric ward. Gastrointestinal bleeding was less frequent. All cases presented a favorable evolution. The need for prevention and education programs to reduce the incidence of these events in the pediatric population is emphasized.

Introduction: Helicobacter pylori is responsible for a highly prevalent bacterial infection in developing countries, and its adequate pharmacological treatment is essential to prevent serious complications such as gastric cancer. However, at present, the usual treatment has significant failure rates, and its main factor is bacterial resistance.

Aim: To identify the frequency and risk factors for resistance to clarithromycin, amoxicillin, azithromycin, metronidazole, and levofloxacin in patients with Helicobacter pylori infection in the Gastroenterology Center, Cuenca, between December 2020 and May 2021.

Material and methods: A Single-center observational and descriptive study of 157 adult patients who underwent endoscopic procedures and biopsies that were cultured to obtain resistance rates to different antibiotics. Patients were excluded if they did not sign the informed consent if they had received treatment with antibiotics, bismuth and/or proton pump inhibitors, at least two weeks before the procedure, and if they had received prior treatment for Helicobacter pylori, or with upper gastrointestinal bleeding. Information was collected using a form: age, sex, sociodemographics, and access to public services. Data were presented in tables, with relative frequencies and percentages. Pearson's Chi-square test was used to assess the association between variables. Statistically significant association when p < 0.05.

Results: The prevalence of H. pylori infection was 31.2% by urea test and 12.1% by 48-hour culture. The lowest percentage of resistance was observed for levofloxacin (0%), followed by azithromycin at 16.7%; clarithromycin at 21.1%; amoxicillin 25 mcg at 26.3%; amoxicillin 10 mcg at 31.6% and with the highest percentage of resistance, metronidazole at 63.2%. Resistance to metronidazole and amoxicillin 25 mcg was only significantly associated with patient age, being higher in those older than 60 years.

Conclusions: Metronidazole had a high resistance rate in the sample, while levofloxacin had a sensitivity of 100%. Resistance to metronidazole and amoxicillin 25 mcg was associated with patient longevity.

Introduction: The liver is an organ that is affected by multiple mechanisms in the presence of COVID-19. The aim of this study was to determine whether elevated alanine aminotransferase, aspartate aminotransferase and total bilirubin levels are predictors of mortality in adults with COVID-19.

Materials and methods: Retrospective cohort study of adults hospitalized between 2020 and 2022 at a university hospital in Bogotá for COVID-19 and hypoxemia. All-cause mortality was the primary outcome. An independent multivariate model was built for each of the following markers of liver injury: alanine aminotransferase, aspartate aminotransferase and total bilirubin. Each model was adjusted by age, presence of diabetes mellitus, presence of fever during hospitalization, lymphocyte count, D-dimer and lactate dehydrogenase.

Results: A total of 704 patients were included. The mortality rate was 38%. Elevated alanine aminotransferase, aspartate aminotransferase and total bilirubin levels on admission were reported in 64%, 64% and 8.3% of patients, respectively. According to the multivariate analysis, the elevation of both aspartate aminotransferase (OR = 1.06, 95% CI: 1.02-1.11 for each 40 U/L increase, p - value = 0.009) and total bilirubin levels (OR = 1.26, 95% CI: 1.08 -1.47 for every rise in 1mg/dl, p - value = 0.003) were independently associated with death. Total bilirubin level was also associated with intensive care unit admission, need for invasive mechanical ventilation, and length of hospital stay. The results for alanine aminotransferase did not allow us to conclude an independent association with death. Age, fever and lowest lymphocyte count during hospitalization were also associated with death.

Conclusion: Elevated transaminases and total bilirubin levels are frequent findings in patients with COVID-19 and hypoxemia. Aspartate aminotransferase and total bilirrubin were predictive of mortality in these patients, so their measurement on admission is a reasonable practice. Progress needs to be made in incorporating these markers into predictive models of mortality and clinical decision rules.

Introduction: Recently, a subcutaneous formulation of infliximab was approved. The switch from intravenous infliximab to subcutaneous infliximab may improve convenience, but data on pharmacokinetics and immunogenicity are limited. We aimed to compare the efficacy and tolerability of subcutaneous infliximab and to assess whether the formulation results in higher plasma levels of infliximab.

Methods: Retrospective, single-center cohort study. Patients with Crohn's disease or ulcerative colitis, 18 years of age or older, clinically stable, receiving intravenous infliximab (5mg/kg every eight weeks) for more than 6 months were switched. Subcutaneous infliximab (120 mg) was administered every 2 weeks. Clinical and analytical evaluations were performed on day 0, week 2, week 8, and week 16. Plasma levels of infliximab and anti-drug antibodies were measured at these time points.

Results: 41 patients included (27 with Crohn's disease and 14 with ulcerative colitis. Azathioprine was administered concomitantly in 47.6%. All patients remained in clinical remission. Analytical biomarkers remained stable. Treatment persistence: 95.1%. Median plasma levels of infliximab at day 0, week 2, week 8, and week 16: 4.89 (3.25 - 7.27), 9.17 (7.89 - 12.6), 19.91 (15.02 - 21.64) and 21.55 (17.18 - 29.57) ug/mL, respectively. Statistically significant difference of plasma levels of infliximab in day 0 vs. week 2 and week 2 vs week 8. Azathioprine resulted in a statistically significant difference in plasma levels of infliximab only at day 0 (not at week 2, week 8, or week 16). Plasma levels of infliximab at week 2, week 8, and week 16, but not at baseline, were statistically associated with body mass index. No anti-drug antibodies were detected. No severe adverse effects. Three patients developed injection site reactions. Three patients developed arthralgia of undetermined significance.

Conclusions: Switching from intravenous infliximab to subcutaneous infliximab maintained clinical response. Plasma levels of infliximab at week two were still lower than expected, considering the results at week eight. A possible advantage of subcutaneous infliximab may be the diminished necessity for concomitant immunomodulators.

Autoimmune pancreatitis is a specific form of chronic recurrent pancreatitis whose etiopathogenesis involves immunological mechanisms. Historically, two varieties of the disease have been described, each with clinical, biochemical and histological particularities. Recently, a third subtype has been described as a consequence of the adverse effects associated with immunotherapy, which is increasingly indicated for several tumors. The diagnosis of autoimmune pancreatitis is a challenge for professionals, in part because of its heterogeneous clinical presentation, which includes obstructive jaundice in type 1 autoimmune pancreatitis and abdominal pain in type 2, and can mimic more serious pathologies such as pancreatic ductal adenocarcinoma. Serum biomarkers (IgG4) play an important role in the diagnosis, but they can sometimes be normal, especially in type 2 autoimmune pancreatitis, or be elevated in other pathologies. Non-invasive imaging techniques, in particular magnetic resonance cholangiopancreatography with intravenous contrast, play a central role in the diagnostic process of the disease. In this article, we review the imaging aspects of autoimmune pancreatitis and the extrapancreatic manifestations of systemic IgG4 disease, the features that differentiate it from pancreatic cancer and we evaluate the radiological criteria for response to corticosteroid treatment.

Granular cell tumor is a neoplasm that originates from Schwann cells. Esophageal localization is rare. Although certain endoscopic features characterize these lesions, endoscopic ultrasound together with histopathological examination with immunohistochemical analysis are essential for their correct diagnosis.

Case report: A 56-year-old male consulted for dysphagia and pyrosis. Endoscopic examination revealed an elevated subepithelial lesion in the lower third of the esophagus with areas of mucosal erosion. Echoendoscopy showed a hypoechogenic lesion with defined borders located on the muscularis mucosae layer. The lesion was removed using an endoscopic submucosal dissection technique. Finally, after the use of immunohistochemistry, the diagnosis of granular cell tumor was reached, with positive expression of S100 protein and CD68 marker.

Conclusion: Granular cell tumor is a rare cause of esophageal subepithelial lesion. Its main differential diagnosis is stromal tumor. Echoendoscopy and histopathologic analysis with the use of immunohistochemistry are essential for its correct diagnosis and subsequent treatment.

Introduction: . Patients with esophageal motility disorders may present different symptoms. Dysphagia is the most common symptom, but it may also present with reflux symptoms (mainly regurgitation) and/or chest pain. Data on the prevalence of esophageal motility disorders, according to the different presenting symptoms in the Argentine population, are scarce.

Aim: To describe the symptom profile and determine the prevalence of esophageal motility disorders based on each symptom.

Material and methods: Retrospective analysis of prospectively conducted studies. Patients with esophageal symptoms who underwent high-resolution esophageal manometry from January 2009 to December 2020 were included. High-resolution manometry was performed with a system of 36 circumferentially sensitive solid-state sensors and patients were classified using the Chicago Classification v3.0.

Results: Of the 861 patients studied (mean age 57 +/- 16 years; 71.2% women), 304 had dysphagia, 462 had gastroesophageal reflux symptoms, 89 had chest pain, and 6 had a combination of symptoms. Among patients with dysphagia, 38.16% had achalasia. Among patients with gastroesophageal reflux symptoms, 63.2% had normal esophageal motility and 18% had ineffective esophageal motility. Among patients with chest pain, 67% had normal esophageal motility and 13% had ineffective esophageal motility. The odds ratio for achalasia in patients with dysphagia was 38 (95% CI 19-86, p = 0.000).

Conclusion: Gastroesophageal reflux symptoms were the most common presentation, followed by dysphagia. Achalasia was the most common manometric finding in patients with dysphagia and ineffective esophageal motility in patients with gastroesophageal reflux and chest pain. This study highlights the high prevalence of achalasia in patients with dysphagia and ineffective esophageal motility in patients with gastroesophageal reflux and chest pain.